Effects of lidocaine, ketamine, and remifentanil on withdrawal response of rocuronium

Abstract

BackgroundRocuronium has been well known to produce withdrawal response in 50-80% patients when administered intravenously. Several drugs are administered prior injection of rocuronium to prevent the withdrawal response. We compared the preventive effect of lidocaine, ketamine, and remifentanil on the withdrawal response of rocuronium.MethodsA total of 120 patients undergoing various elective surgeries were enrolled. Patients were allocated into 4 groups according to the pretreatment drugs (Group N, normal saline; Groups L, lidocaine 40 mg; Group K, ketamine 0.5 mg/kg; Group R, remifentanil 1 µg/kg). Patients received drugs prepared by dilution to 3 ml volume before injection of rocuronium. Withdrawal responses after injection of rocuronium were graded on a 4-point scale. Hemodynamic changes were observed before and after administration of pretreatment drugs and after endotracheal intubation.ResultsIncidence of withdrawal response was significantly lower in group L (20%), group K (30%), and group R (0%), than group N (87%). Severe withdrawal response was observed in 5 of the 30 patients (17%) in group L, and in 9 of the 30 patients (30%) in group K. There was no severe withdrawal response in group R. Mean blood pressure and heart rate were significantly decreased in group R compared to other groups.ConclusionsIt seems that remifentanil (1 µg/kg intravenously) was the strongest and most effective in prevention of withdrawal response after rocuronium injection among the 3 drugs.

Combination of nefopam and remifentanil is more effective to reduce rocuronium-induced withdrawal response compared with remifentanil alone: a prospective, double-blinded, randomized control study

“…Most previous studies reported that single bolus doses of remifentanil (0.5 or 1 mg/kg) were effective in reducing the incidence of rocuronium-induced withdrawal response to 0% to 6.3% [1,9,15,16]. Instead of a single injection, we can also administer remifentanil using a TCI pump.…”

“…In the control group (n = 38), 102 ml of 0.9% sodium chloride solution was infused one hour before surgery at a rate of 100 ml/h. In the nefopam group (n = 38), 20 mg nefopam (2 ml) in 100 ml of 0.9% sodium chloride solution was infused one hour before surgery at a rate of 100 ml/h ( [9]. We defined moderate to severe withdrawal response using grade > 1 as the cutoff for significant rocuronium-induced withdrawal response.…”

“…Many clinical studies have tried to reduce the withdrawal response by various pharmacological interventions [2][3][4][5][6][7][8][9][10].…”

“…Most reported that lidocaine and remifentanil were effective in reducing the incidence of rocuronium-induced withdrawal response [1,6,9]. Some authors suggested that non-opioid analgesics such as tramadol and paracetamol also effectively reduced rocuronium-induced withdrawal response, even though their effects were less than that of lidocaine [4,6].…”

Perioperative adrenergic response and the use of beta-blockers

“…Remote cerebella hemorrhage, due to massive loss of cerebrospinal fluid, represents a rare postoperative anesthesia-related complication of supratentorial or spinal surgical procedures [ 3 ]. As reported in a case included in this issue [ 4 ], early diagnosis of remote cerebella hemorrhage is extremely important for successful patient management, and to avoid further aggravating potentially fatal and permanent neurologic damage. However, its diagnosis, which relies on assessment of the patient's neurological symptoms and diagnostic brain imaging, is frequently delayed, especially during the immediate postoperative period: certain symptoms can be difficult to discern, or might be concealed, by residual anesthesia effects or postoperative surgical pain.…”